Endocrine Dysfunction following Traumatic Brain Injury in Children

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This study included a prospective evaluation of 31 children after traumatic brain injury (TBI).

The researchers evaluated thyroid function, insulin-like growth factor I, insulin-like growth factor-binding protein 3, and cortisol at 1, 3, 6, and 12 months after injury, and assessed prolactin at 3 and 6 months. At 6 months, they also assessed overnight growth hormone secretion, nocturnal thyrotropin surge, adrenal reserve, and serum and urine osmolarity.

The average patient age was 11.6 years, and mean Glascow Coma Scale score was 6.

The incidence of endocrine dysfunction was 15% at 1 month, 75% at 6 months, and 29% at 12 months.

At 12 months after injury, 14% had precocious puberty, 9% had hypothyroidism, and 5% had growth hormone deficiency.

Endocrine dysfunction after TBI is common in children, but most cases resolve by 1 year. The study authors recommended endocrine surveillance at both 6 and 12 months following moderate or severe TBI.

References:
Endocrine Dysfunction following Traumatic Brain Injury in Children, Volume 157, Issue 6, Pages 894-899 (December 2010).

Pediatric concussions: 69% by boys, 30% sports-related

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This is a cross-sectional study of children 0 to 19 years old diagnosed with concussion from the National Hospital Ambulatory Medical Care Survey.

There were 144 000 concussions annually.

69% of concussion visits were by males. 30% were sports-related.

69% of patients diagnosed with a concussion had head imaging.

28% of patients were discharged without specific instructions to follow-up with an outpatient provider for further treatment.

References:

Pediatric Concussions in United States Emergency Departments in the Years 2002 to 2006. William P. Meehan III, MDab, Rebekah Mannix, MD, MPHa. The Journal of Pediatrics.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.
Image source: Illustration of the human brain and skull. Wikipedia, Patrick J. Lynch, medical illustrator, Creative Commons Attribution 2.5 License 2006.

Number of traumatic brain injuries during kids' basketball games increased by 70%

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A retrospective analysis was conducted with data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, from 1997 to 2007.

An estimated 4 million pediatric basketball-related injuries were treated in emergency departments.

The total number of injuries decreased during the study period but the number of traumatic brain injuries (TBIs) increased by 70%.

The most common injury was a strain or sprain to the lower extremities (30.3%), especially the ankle (23.8%).

Boys were more likely to sustain lacerations and fractures or dislocations.

Girls were more likely to sustain TBIs and to injure the knee.

Older children (15–19 years of age) were 3 times more likely to injure the lower extremities.

Younger children (5–10 years of age) were more likely to injure the upper extremities and to sustain TBIs and fractures or dislocations.

Although the total number of basketball-related injuries decreased during the 11-year study period, the large number of injuries in this popular sport is cause for concern.

References:
Basketball-Related Injuries in School-Aged Children and Adolescents in 1997–2007. PEDIATRICS Vol. 126 No. 4 October 2010, pp. 727-733 (doi:10.1542/peds.2009-2497)

Drowning Prevention Guidelines - Cleveland Clinic Video

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Drowning Doesn’t Look Like Drowning

- Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.

- Drowning people’s mouths alternately sink below and reappear above the surface of the water.

- The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.

- Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.

- Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.

- From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

References:
Drowning Doesn’t Look Like Drowning. Mario Vittone.

On Scene Magazine: Fall 2006 (page 14)

Battery-Ingestion Epidemic

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Battery Ingestions:

- most often obtained directly from a product (61.8%)
- were loose (29.8%)
- were obtained from battery packaging (8.2%)

Of young children who ingested the most hazardous battery, the 20-mm lithium cell, 37.3% were intended for remote controls.

Adults most often ingested batteries that were sitting out, loose, or discarded (80.8%); obtained directly from a product (4.2%); obtained from battery packaging (3.0%); or swallowed within a hearing aid (12.1%). Batteries that were intended for hearing aids were implicated in 36.3% of ingestions. Batteries were mistaken for pills in 15.5% of ingestions, mostly by older adults.

http://pediatrics.aappublications.org/cgi/content/abstract/125/6/1178?rss=1

There was a 6.7-fold increase in the percentage of button battery ingestions with major or fatal outcomes from 1985 to 2009 (National Poison Data System). Ingestions of 20- to 25-mm-diameter cells increased from 1% to 18% of ingested button batteries (1990–2008), paralleling the rise in lithium-cell ingestions (1.3% to 24%).

Outcomes were significantly worse for large-diameter lithium cells (20 mm) and children who were younger than 4 years. The 20-mm lithium cell was implicated in most severe outcomes. Severe burns with sequelae occurred in just 2 to 2.5 hours. Most fatal (92%) or major outcome (56%) ingestions were not witnessed. At least 27% of major outcome and 54% of fatal cases were misdiagnosed, usually because of nonspecific presentations. Injuries extended after removal, with unanticipated and delayed esophageal perforations, tracheoesophageal fistulas, fistulization into major vessels, and massive hemorrhage.

References:

A Lithium Battery in a Hotdog: the picture burns itself into mind - keep out of reach of small children http://goo.gl/qHsBL

http://pediatrics.aappublications.org/cgi/content/abstract/125/6/1168?rss=1

Image source: Amazon, for illustrative purposes only, NOT a suggestion to buy any product.